Please fill in the whole form including official use box using a ball point pen and send it to:
Blood Pressure UK
The Wolfson Institute Charterhouse Square London EC1M 6BQ
Name(s) of Account Holder(s)
Bank / Building Society Account Number
Branch Sort Code
Name and full postal address of your Bank or Building Society
Instruction to your Bank or Building Society to pay by Direct Debit
Service User Number
FOR Blood Pressure UK OFFICIAL USE ONLY This is not part of the instruction to your Bank or Building Society IMPORTANT - Please complete these details:
Account Holder(s) Name & Address
Instruction to your Bank or Building SocietyPlease pay Blood Pressure UK Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Blood Pressure UK and, if so, details will be passed electronically to my Bank / Building Society.
|This Guarantee should be detached and retained by the payer.|
|The Direct Debit Guarantee|
- This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
- If there are any changes to the amount, date or frequency of your Direct Debit Blood Pressure UK will notify you 5 working days in advance of your account being debited or as otherwise agreed. If you request Blood Pressure UK to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
If an error is made in the payment of your Direct Debit, by Blood Pressure UK or your bank or building society you are entitled to a
full and immediate refund of the amount paid from your bank or building
- If you receive a refund you are not entitled to, you must pay it back when Blood Pressure UK asks you to.
- You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.